Peripheral Vascular Disorders.

Question 1

Ischemia:

Answer 1

lack of adequate arterial blood supply.

Question 2

Ischemia is caused by:

Answer 2

plaque, spasm, embolus/thrombus, change in BP, blood viscosity, AV fistula – develops as a result of an infectious process in an extremity, trauma, heart failure, compartment Syndrome – swelling cuts off blood flow to extremity.

Question 3

Intermittent claudication:

Answer 3

muscle pain when walking due to lack of oxygen rich blood; goes away when resting.

Question 4

Peripheral arterial disease:

Answer 4

chronic; first s/s is leg cramp; after 75% occlusion, s/s so severe they will seek attention.
if larger artery is occluded: balloon/stent.
if smaller artery: femoral popliteal bypass.

Question 5

S/S of PAD:

Answer 5

claudication, pain at rest, sparse hair, slow growing nails/thick, dry/scaly skin, cool, decreased pulses, pale, red/rubor with dependent position, decreased motor function, ankle brachial index of -0.5-.95, ulceration - painful/crusty - gangrene may develop.

Question 6

Dx of arterial occlusion:

Answer 6

doppler, ABI, MRI, arteriogram.

Question 7

Tx of PAD:

Answer 7

medications (vasodilators or antiplatelets), CCB, thrombolytics (if acute, will be given first), angioplasty/stents, atherectomy, embolectomy, bypass, amputation.

Question 8

Buerger’s disease:

Answer 8

thromboangiitis obliterans; inflammation; smoking increases risk; fibrotic areas, small and medium arteries, gangrene and necrosis progression; blood vessels become inflamed, swell, and blocked with thrombi.
occur in males more than females.

Question 9

Tx of Buerger’s:

Answer 9

no vasodilators (won’t work), quit smoking, avoid cold, amputation.

Question 10

Raynaud’s disease:

Answer 10

vasospasm of small arteries; associated with SLE, RA, or trauma; risk factors: cold, smoking, stress, caffeine.
will have white places where the spasms are occurring; painful, tingly.
amputation not common.
occur in females.

Question 11

S/S of Raynaud’s:

Answer 11

bilaterial, pallor then cyanosis then rubor; radial and ulnar pulses intact; episodic; worse in the winter.

Question 12

Tx of Raynaud’s:

Answer 12

prevent spasm - avoid cold and stimulants, layer clothing, mittens not gloves, stress reduction; avoid diet pills and energy drinks.

Question 13

Risk for DVT:

Answer 13

age, females, hypercoagulable (birth control), immobility, vessel damage, sickle cells, trauma, oral contraceptives, COPD, heart disease.

Question 14

S/S of DVT:

Answer 14

cord like, tenderness, unilateral swelling, 50% asymptomatic, s sign, fever, positive u/s.

Question 15

Tx of DVT:

Answer 15

anticoagulant (Heparin or Lovenox), Warfarin, thrombolytics; TED, compression stockings, external penumatic compression, early ambulation, vena cava filter.

Question 16

Varicose veins:

Answer 16

increased pressure in the veins, failing valves.

Question 17

Risk of varicose veins:

Answer 17

obesity, prolonged, standing, pregnancy, increased intra-abd pressure.

Question 18

Tx of varicosities:

Answer 18

regular exercise, elevate LE, support stocking, sclerotherapy (vein stripping), weight loss, teach s/s of infection.

Question 19

Risk for venous stasis ulcer:

Answer 19

venous HTN, infection, DM, malignancy, connective tissue disorder, trauma, pressure, insect bites.

Question 20

Tx of ulcer:

Answer 20

compression, elevation, topical wound care, vein removal (80% more likely to have a problem if veins removed).

Question 21

Arterial s/s:

Answer 21

intermittent claudication, decreased/absent pulses, pale if elevated, red if dependent, cool, no edema, thin/shiny skin, little to no hair, nails thick and rigid, ulceration on toes or points of trauma, gangrene.

Question 22

Venous s/s:

Answer 22

no pain to aching on dependency, normal pulses unless edema, normal color - may see bronzing, normal temp, edema present, brown discoloration; ulcers usually medial side; no gangrene.